Assuming that Republican Scott Brown stunningly triumphs tonight in the Massachusetts Senate race - and we do need to be wary of assumptions, given how Hillary Clinton shattered conventional wisdom by winning the '08 New Hampshire primary - observers will surely point out that the Bay State's special election was virtually the mirror opposite of Pennsylvania's special Senate election back in 1991.

Scott Brown has stumped Massachusetts with the pledge that he will be the 41st Senate vote (and thus, potentially, the fatal vote) against health care reform; erasing a recent 30-point deficit in the polls, he has galvanized angry voters by defining himself as the anti-incumbent, anti-establishment candidate, and by arguing that the Democrats' health reform push is proof that the ruling party is out of touch with ordinary people. (Plus, Brown has been greatly aided by his Democratic opponent, state attorney general Martha Coakley, who until recently treated the election like a coronation and is so clueless that she recently insisted in a radio interview that Red Sox legend Curt Schilling is a Yankee fan.)

Now let's rewind to Pennsylvania in the autumn of 1991, and the special election to fill the seat vacated by Republican John Heinz, who had been killed in a plane crash. What happened then was the reverse of what appears to be happening now.

Democrat Harris Wofford stumped Pennsylvania with the pledge that he would push hard in favor of health care reform. Erasing a 44-point deficit in the polls, he successfully galvanized angry voters by defining himself as the anti-establishment, anti-incumbent candidate - at a time when the Republicans held the White House. The nation was roiled by a recession, President George H. W. Bush was perceived as being inattentive to domestic concerns - and, most importantly, Wofford argued that Bush's lack of interest in health care reform was proof that he was out of touch with ordinary people. (Plus, Wofford was greatly aided by his Republican opponent, former U.S. attorney general Dick Thornburgh, who treated the election like a coronation, and was so clueless that, until the eleventh hour, he didn't know how to pronounce Wofford's name.)

I didn't cover that '91 race (Wofford's stunning win was interpreted, rightly, as an early harbinger of Bush's vulnerability in 1992), but a quick check of the archives brings it all freshly to mind. Pennsylvania voters, already angered by the recession and a huge savings & loan scandal, basically signaled that they wanted health care reform, and they perceived Thornbugh's opposition to the issue (as well as Bush's opposition) as symptomatic of the GOP's distance from everyday concerns. Indeed, the Bush White House had previously set up a health care reform commission to the study the issue, and the study had concluded in 1990 that the government should offer an insurance program of its own (sound familiar?), whereupon the White House did nothing.

In other words, health care reform that year was the electoral insurgents' magic bullet; after Wofford waxed Thornburgh by 10 points, he declared, "we can't wait for national health insurance," and that voters were clearly demanding prompt action. Bush was even prompted to concede that voters "are interested in health care...and all of that." And as Thornburgh strategist Greg Stevens reportedly lamented after his candidate lost, "We were smacked by a tidal wave...It was driven by economics. Wrapped into that was the anti-incumbency, anti-establishment, anti-Washington sentiment."

So the obvious question is: Why has health reform - once the rallying cry for insurgent voters - apparently become the whipping boy for insurgent voters? Once the issue that buoyed Democratic fortunes in Pennsylvania, why is it now apparently a drag on Democratic fortunes in Massachusetts, a symbol of out-of-touch incumbency?

One obvious answer: Americans have long harbored contradictory views on the issue. The two elections show the contradiction.

Mindful of the high costs and inequities of private health insurance, people have generally supported the idea of reform. But they're generally wary about the necessary tradeoffs - giving up something to get something new, paying more now for better benefits down the road, or even paying for it at all. In that 1991 race, health reform was framed only as an aspiration, as a vehicle for disenchanted, anti-establishment voters. Indeed, Wofford never spelled out any health reform legislative proposal; in terms of how reform would actually be structured, he offered few details - mindful, no doubt, that such details might thwart his upward trajectory.

Meanwhile, on that same election day in 1991, the voters of New Jersey gave us a window into the public's contradictory views. On the one hand, they swept the Republicans into power in the state legislature, because they were ticked off about high state taxes. On the other hand, 80 percent of them voted in favor of a non-binding ballot referendum that urged Bush and the Congress to enact "high quality, comprehensive" national health care...a purely aspirational vote, because there was nothing in the referendum about tradeoffs.

And now, on the eve of the Massachusetts Senate vote, the health care debate is all about the details and the tradeoffs. Worse yet for the Democrats, the details have consumed so much congressional energy that it appears, at least to the angriest motivated voters, that scant time has been spent on addressing the deep recession. Whereas, in 1991, the Pennsylvania Democrats were able to successfully link anger over the recession with anger over the lack of health reform, the Massachusetts Republicans have apparently remixed the formula, redefining voters' economic anxieties.

There will be plenty of time to interpret the actual election results. But regardless of wins or loses, health reform will continue to hang by a thread. There's no point in being optimistic about the prospects for passage. After all, consider what the Inquirer's Washington bureau reported on Nov. 17, 1991, in the wake of Wofford's dramatic win:

"America's health care system is like a house whose owners have let it slide into decay. But despite new urgency in the national debate over health care, experts on all sides say that a consensus on comprehensive reform to guarantee coverage for all is at least...two years away."